The Algarve region is the southernmost region of mainland Portugal, with an area of 5.412 km2. The population of the region is served by a single public health center, the “Algarve Local Health Unit”, with two Stroke Units (SUs), strategically located in Faro and in Portimão. The stroke team in Algarve is highly experienced and has gained national and international recognition for its quality of care and research.

The Algarve Local Health Unit is equipped with advanced diagnostic equipment, including CT scans and MRI machines, which are essential for determining the type of stroke and planning treatment.

Having these two SUs guarantees an average maximum delay of 60 minutes from almost all geographical points in the region to the treatment when the transportation is made by the Pre-Hospital Emergency System. This means that prompt recognition and calling 112 largely determines the prognosis of stroke patients in the Algarve.

How to recognize an acute stroke?

A stroke results from a disruption in the blood flow to the brain, leading to a sudden loss of brain function. There are two main types of stroke: ischemic (caused by a blockage in a blood vessel) and hemorrhagic (caused by bleeding). Regardless of the type, a stroke is a medical emergency that requires immediate attention.

Recognizing the signs of a stroke quickly is crucial for improving outcomes (Figure 1).

Credits: Supplied Image; Author: Client;

Representation of most common manifestations of stroke, F (face asymmetry), A (arm weakness), S (speech difficulty) and T (time to act, call 112 in Portugal). Source: https://www.mass.gov/info-details/stroke-signs-and-symptoms-act-fast

Yet, it is worthwhile to highlight that the presence of any acute neurological deficit should be considered a stroke until proven otherwise. This is important because stroke can manifest in various ways, such as sudden confusion or difficulty seeing in one or both eyes; loss of balance, coordination, or even sudden severe headache without a known cause.

Why is time so important in acute stroke?

As in the rest of Portugal, patients with acute stroke should be transported to a hospital capable of providing immediate acute treatment. The two SUs have the capability to provide treatments to remove the thrombus (thrombolysis and thrombectomy), reopening the arteries in patients with acute ischemic stroke. In a typical large ischemic stroke, every minute that therapy is delayed, 2 million brain cells die, and for every four minutes of delay, 1 of every 100 patients has a worse disability outcome (unable to walk unassisted). For this reason, the national ideal target for the time interval from patient arrival in the emergency department to arterial puncture for treatment is 60 minutes.

In the case of intracerebral hemorrhage, time is also important to give the patient an opportunity to benefit from interventions such as blood pressure control and reversal of coagulation problems, which have been shown to reduce the expansion of the bleed within the brain, leading to a better outcome.

What should I do immediately at the slightest suspicion of a stroke?

The first and most critical action is to call Emergency Services Immediately (112). In emergency cases, access to the Portuguese National Health Service is universally free. When calling, remain calm and provide the dispatcher with the following information:

  • Your exact location - Be ready to give your address, nearby landmarks, or the name of the hotel or resort if you are a visitor.
  • A description of the symptoms - Clearly state that you suspect the person is having a stroke.
  • Any other important information, such as whether the person is conscious or breathing.

The dispatcher will guide you on what to do next and send an ambulance to your location. In the Algarve, emergency medical services are generally very responsive, but the sooner you act, the better the chances for a positive outcome.

What to do while waiting for help?

While waiting for medical help to arrive, make sure the person remains as safe, calm and comfortable as possible:

  • Lay them down in a safe position
  • Avoid food or drink: Do not offer food, water, or medication as a stroke can impair swallowing and increase the risk of choking.
  • Monitor their breathing: If the person becomes unconscious, check their breathing and ensure their airway is clear. If necessary, perform CPR only if you are trained to do so.

Stay with the person and reassure them until help arrives. If the stroke victim is unconscious but breathing, it’s crucial to stay calm and avoid panicking.

What to expect when help arrives?

In the Algarve, emergency medical teams are highly trained in dealing with stroke. When they arrive, they will assess the patient and begin immediate treatment. The ambulance crew will transport the individual to one of the two SUs, where the stroke team will pursue the fastest and most appropriate acute management.

In conclusion, if a stroke is suspected, the most important decision is to call 112 immediately. This single, simple decision will save brain cells and dramatically increase the odds of recovering from a stroke.

Main image: Members of the two stroke units of the Algarve Local Health Unit with the Angels Award for excellence of care from the European Stroke Organization. https://www.chualgarve.min-saude.pt/noticias/unidades-de-avc-da-uls-algarve-distinguidas-com-diamante-ouro-e-platina-nos-eso-angels-awards/

by Prof. Dr. Hipólito Nzwalo - Regional Coordinator for the Stroke Code in Algarve